Prognostic Value of the Circumferential Resection Margin After Curative Surgery For Rectal Cancer: A Multicenter Propensity Score-Matched Analysis.

Autores de IIS La Fe

• Blas Flor Lorente

  Autor

• Eduardo García-Granero Ximénez

  Autor

Participantes ajenos a IIS La Fe

• Galvez, Ana
• Biondo, Sebastiano
• Trenti, Loris
• Espin, Eloy
• Kraft, Miquel
• Farres, Ramon
• Codina-Cazador, Antonio
• Enriquez-Navascues, Jose M.
• Borda-Arrizabalaga, Nerea
• Kreisler, Esther

Grupos

• Cirugía digestiva y Cuidados perioperatorios

Abstract

BACKGROUND: In the past few years, positive circumferential resection margin has been found to be an indicator of advanced disease with high risk of distant recurrence rather than of local recurrence. OBJECTIVE: The objective was to analyze the prognostic impact of circumferential resection margin on local recurrence, distant recurrence, and survival rates in patients with rectal cancer. DESIGN: This was a multicenter, propensity score-matched analysis 2:1 comparing positive and negative circumferential resection margin. SETTINGS: The study was conducted at 5 high-volume centers in Spain. PATIENTS: Patients who underwent total mesorectal excision with a curative intent for middle-low rectal cancer between 2006 and 2014 were included. Clinical and histological characteristics were used for matching. MAIN OUTCOME MEASURES: The main outcomes were local recurrence, distant recurrence, overall survival, and disease-free survival. RESULTS: The unmatched initial cohort consisted of 1599 patients; 4.9% had a positive circumferential resection margin. After matching, 234 patients were included (156 with negative circumferential margin and 78 with positive circumferential margin). The median follow-up period was 52.5 months (22.0-69.5). Local recurrence was significantly higher in patients with positive circumferential margin (33.3% vs 11.5%; HR 3.2; 95% CI: 1.83-5.43; p < 0.001). Distant recurrence was similar in both groups (46.2% vs 42.3%; HR 1.09; 95% CI: 0.78-1.90; p = 0.651). There were no statistically significant differences in 5-year overall survival (48.6% vs 43.6%; HR 1.09; 95% CI: 0.92-1.78; p = 0.14). Disease-free survival was lower in patients with positive circumferential margin (36.1% vs 52.3%; HR 1.5; 95% CI: 1.05-2.06; p = 0.026). LIMITATIONS: This study was limited by its retrospective design. The different neoadjuvant treatment options were not been included in the propensity score. CONCLUSIONS: Positive circumferential resection margin is associated with higher local recurrence rate and worse disease-free survival in comparison with negative circumferential resection margin. However, positive circumferential resection margin was not a prognostic indicator of distant recurrence and overall survival. See Video Abstract at http://links.lww.com/DCR/B950.

Copyright © The ASCRS 2022.

Keywords

• adult; aged; Article; cancer prognosis; cancer recurrence; cancer surgery; cancer survival; clinical outcome; cohort analysis; controlled study; disease free survival; distant recurrence free survival; female; follow up; histopathology; human; local recurrence free survival; long term survival; major clinical study; male; overall survival; rectum; rectum cancer; recurrence risk; retrospective study; surgical margin; survival rate; cancer staging; clinical trial; epidemiology; multicenter study; pathology; prognosis; propensity score; rectum tumor; surgery; tumor recurrence; Humans; Margins of Excision; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Propensity Score; Rectal Neoplasms; Rectum; Retrospective Studies